Assessing the safety and efficiency of a simplified diagnostic approach to deep vein thrombosis
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Authors
Soon, Linnea Claire Locklin
Date
2025-05-23
Type
thesis
Language
eng
Keyword
Deep vein thrombosis , Venous thromboembolism , Emergency department
Alternative Title
Abstract
Background: Deep vein thrombosis (DVT) testing in the emergency department is complex and difficult to consistently apply. To address this, we developed the ToDay algorithm.
Objectives: The objective was to assess the safety and efficiency of the ToDay algorithm. A secondary exploratory analysis evaluated applying different D-dimer thresholds.
Methods: This prospective diagnostic management study was conducted at two emergency departments in one city. Patients with suspected DVT were potentially eligible for enrollment. Enrolled patients were followed by medical record review for 90 days. All venous thromboembolism (VTE) testing during follow-up was independently adjudicated. The primary outcomes were safety, measured by the failure rate, and efficiency of the ToDay algorithm. The failure rate is the proportion of patients with DVT ruled out at the index presentation that were diagnosed with VTE in the following 90 days. Efficiency is the proportion of patients that do not require an ultrasound to rule out DVT. Six other diagnostic strategies consisting of standalone D-dimers and D-dimers in low pretest probability patients were retrospectively assessed to estimate safety and efficiency.
Results: Thirty-three (7.2%) out of 458 enrolled patients were diagnosed with DVT at their index visit. There were two follow-up VTE events. The ToDay algorithm had a failure rate of 0.5% (95% confidence interval (CI); 0.1 – 1.7%). The ToDay algorithm had an efficiency of 43.7% (95% CI; 39.2 – 48.2%).
Using the six other simple diagnostic strategies, the failure rates ranged from of 0.0% to 0.7%. Using these six strategies, the efficiencies ranged from 30.6% to 61.8%.
Conclusion: The ToDay algorithm had a failure rate of 0.5% and an efficiency of 43.7%. All other strategies had low failure rates with varying efficiencies.
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Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NoDerivatives 4.0 International